Week 1 part 1 Flashcards
Give three factors in human ageing?
- Random molecular damage during cell replication
- Inactivity, poor diet, inflammation increase damage
- Reduction in body’s adaptive reserve capacity
What is the end part of each chromosome arm?
Telomere
What happens when each telomere progressively shortens with each cell replication?
Senescence
What can telomerase do?
Re-extend shortened telomeres - active in some cells like immune cells, stem cells
What 4 main cellular responses does damage cause?
- Repair
- Apoptosis
- Senescence
- Malignant transformation
What term is given to loss of homeostasis and resilience and increased vulnerability to decompensation after a stressor event?
Frailty
What is sarcopenia?
Age related loss of muscle mass and function
What are the three criteria for sarcopenia?
- Low muscle mass
- Low muscle strength
- Low physical performance
What is sarcopenic obesity?
Loss muscle mass with increased fat
What can cause increased risk of cardiometabolic disorders such as insulin resistance, metabolic syndrome or cardiovascular disease?
Sarcopenic obesity
How do you treat sarcopenia?
Exercise
In palliative care what is the smoothest delivery of medicines?
Syringe driver
At end of life what do you prescribe for pain/SOB?
Morphine
At end of life what do you prescribe for distress?
Midazolam
At end of life what do you prescribe for nausea/agitation?
Levomepromazinr
At end of life what do you prescribe for respiratory secretions?
Buscopan
Rapidly developing clinical symptoms and/or signs of focal, and at times global, loss of brain function, with symptoms lasting more than 24 hours or leading to death with no apparent cause other than that of vascular origin ?
Stroke
What type of stroke is cardioembolic?
Fibrin dependent “red thrombus”
What type of stroke is platelet dependent “white thrombus” (cf acute coronary syndrome)?
Atheroembolic
What area of the brain controls personality, emotional response and social behaviour?
Frontal lobe
What area of brain is affected when disinhibition, lack of initiative, antisocial behaviour, iompaired memory, incontinence, grasp reflexes and anosmia
Frontal love
What area of the brain controls calculation, language, planned movement and appreciation of size, texture and weight?
Parietal lobe dominant side
What area of brain is affected when dyscalculia, dysphasia, dyslexia, apraxia, agnosia?
Parietal lobe dominant side
What area of brain controls spatial orientation, constructional skills?
Parietal love non domionant side
What area of brain is affected when neglect of non dominant side, spatial disorienttin, constructional apraxia, dressing apraxia and homonymous hemianopia?
Parietal lobe non dominant side
What area of the brain controls auditory perception. speech, language, verbal memory, smell?
Dominant side temporal lobe
When investigation a stroke - how would you identify an infarct or haemorrhage?
CT scan, MRI scan
How do you investigate the aetiology of a stroke?
Carotid scan, angiogram, ECG, echo
How do you manage an acute stroke?
- Thrombolysis
- Imaging
- Swallow assessment
- Antiplatelets
- Stroke unit care
What is the only proven treatment for acute ischaemic stroke?
IV tissue plasminogen activator - dissolves clot (limited less than 4.5 hours from onset)
Name some secondary prevention methods for stroke?
- Anticoagulants if cardioembolic/af
- Antiplatelets if not cardioembolic (first line clopidogrel)
- Stop smoking
- Statins
5 Manage BP
What is disturbance in attention, change in cognition and develops over a short period while fluctuating?
Delerium
What is different between the onset of dementia and delerium?
Slow for dementia. sudden for delerium
What four things diagnose delerium?
- Acute and fluctuating
- Inattention
- Altered level of consciousness
- Disorganised thinking
Give three factors of hyperactive delerium?
Agitated, aggressive, wandering
What is first line medication for delerium?
Haloperidol - excpet parkinsons
What medication is given for patients with delerium and parkinsons?
Quetiapine
When should you use benzodiazepines for delerium?
When alcohol withdrawl
High stepping gait
Rombergs positive
Cervical myelopathy
Altered sensation
Gait wide based
Peripheral neuropathy
Pain/paraesthesia legs
Gait wide-based
Lumbar stenosis
Gait wide based
Cerebellar signs
Cerebella ataxia
Parkinson’s disease
Shuffling gait
Tremor, rigidity, bradykinesia
Loss of executive function
Impaired risk awareness
Dementia
What test can be done for falls?
Romberg test
What environment do acidic drugs require for absoirption?
acidic e.g. phenytoin, aspirin and penicillins
What environment do basic drugs require for absorption?
Diazepam, morphine, pethidine
Do elderly have decreased hepatic metabolism?
Yes due to decreased size, blood flow and disease
What medication doses are effective in elderly?
Low
